1941-02-12MNt r pi, q w= r~ i
AGREBMENT TO PAY FOR HOSPITALIZATION
This agreement made and executed by the undersigned, a political
subdivision of Hennepin County, Minnesota, the 1 2 day of Feb rusty 9
19 ~1• ,and thereafter delivered to the $oard of Public Welfare in the
City of Minneapolis, a political subdivision of Hennepin County, Minnesota,
Witnesseth as Follows:
to That the consideration for this agreement is the general or public
benefit expected to accrue to the undersigned by reason of a strictly limited
emergency hospitalization service eontemp"lated to be extended upon the
application of the andersigned and to be furnished by the Board of Public
Welfare of the City of Minneapolis, Minnesota, at the Minneapolis General
Hospitalo
20 That it has been made known to and is admitted by the undersigned
that the said Minneapolis General $ospital. i.s a strictly public institution
and is maintained and operated by the said City of Minneapolis out of local
tax funds and without profit; and that the said Board of Public Welfare,
in extending the said emergency service, is acting in a purely governmental
and not in a proprietary capacity.
3o That the undersigned will be permitted, under the terms and
conditions herein specified, to make application to the said Minneapolis
General Hospital for the admission and hospitalization therein of a
certain limited class of patients who are residents of Hennepin County,
Minnesota, but who actually reside outside of the pity limits of the said
City of M3.nneapolis~
4a That no such application shall be made except in a case of extreme
emergency and where the want of immediate hospitalization would be likely to
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result in the imminent loss of the life or the permanent crippling or disabling
of the patient for whose benefit the application is wades
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5o That the said Minneapolis General Hospital will not eooept or
admit arty nonresident patient for hospitalization exoept in cases of
emergency as defined in paragraph four hereof and the andersigned
specifioally agrees not to apply for the admission of patients in any
other class.
6o That suoh applications shall be made only f~jr and on behalf of
poor and indigent persons who cannot gain admission ~::o a private hospital
and, in such oases, only where the undersigned is prepared to assume the
responsibility for the payment, to the Minneapolis General Hospital, of
the full expenses of their hospitalization.
7. That application for the admission of any suoh non resident
patient may be made only by a political subdivision of Hennepin County,
Minnesota, and when made by any member of the governing body thereof, by
its chief administrative officer, or by its public relief authorities,
the same shall be conclusively presumed to have been authorized by suoh
political subdivision for the purposes of this agreement.
8o That upon the admission of any patient to the Minneapolis General
Hospital under the terms of this agreement the undersigned Hereby agrees
to assume the responsibility for the payment to the said hospital of the
full expenses of the hospitalization of suoh patient at the rates establish-
ed by the said Board of Public Welfare according to the sohedule hereto
annexed and hereby made a part hereof
9o That the said Board of Public Welfare hereby reserves the right to
change the said sohedule of rates without notice; provided, however, that
no suoh change shall become effective as to the undersigned until the said
Board shall have given written notice thereof.
10. That upon the admission of any patient to the Minneapolis General
Hospital under the terms of this agreement the undersigned shall continue to
be responsible to the City of Minneapolis for the payment to the Minneapolis
General Hospital of the full expense of the hospitalization of suoh patient
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u~atil he shall have been discharged or until the undersigned shall
have removed him or caused him to be removed therefrom
11> All accounts for any such hospitalization will be rendered
by the Minneapolis General Hospital on a monthly basis and shall be
due and payable on or before the tenth day of the calendar month fellow,
ing that in which the services were performed-. Failure to pay any such
account within thirty days from the day of the mailing thereof shall be
considered as sufficient ground for the withdrawal without notice of all
further hospitalization privileges upon any application of the under-
signed~-
12o It is agreed by the undersigned that any and all notices
contemplated or made necessary by this agreement may be sent by first
class mail and that for the purpose of the delivery thereof the, United
States mail shall be deemed to be the agent of the undersignedo
i3 This agreementf when delivered to the Board of Public Welfare
of the City of Minneapolisa Minnesota9 shall be accompanied by a complete
list of the names and addresses of all the members of the governing body
of the undersigned9 of i.ts chief executive officer and of the members of
its public relief authoritiesA which said list snali be certified by
its said chief executive officer and attested by its secretary- It shal)_
be the duty of the undersigned to give the said Board of Public Welfare
written notice of any changes in the said list of officers ands in the
absence of written notice9 said list 'shall be conclusively deemed to be
correct for the purposes of this agreemento
loo This agreement shall be of no force and effect until the Board
of Public Welfare of the City of Minneapolis9 Minnesota, shall first have
notified the undersigned in writing of the receipt and acceptance thereof.
15. Upon the receipt and acceptance of this agreement the same shall
continue from the date of such acceptance and until terminated by a ten
dayts written notice of cancellation duly served by either party heret o
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No such cancellation or termination shall be effective to relieve the
undersigned of the responsibility of making full payment to the said
Minneapolis General Hospital for any hospitalisation theretofore
furnished or then being furnished under the terms hereof.
In Witness Whereof the undersigned has executed this agreement
in the manner provided by lax the day and year first above written.
Witnesseth:
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Village Of Island Park.
Political Subdivision)
Note: This agreement to be acceptable must be duly executed
in the corporate name of the political subdivision making the same,
over the signatures of its-proper officers duly authorized so to do
by the official action of its governing body, and with its corpor~~e
Beal, if any, duly affixed.
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agrer~o-on~ ~rad~ an4 ~z~~a-~eel~y 1~: '~l~.i~-ga ~ou~c~iill
+pt tk~ Vi1lag~r ~Jf I~la~! Park, ]tet~u~d, ~i~riss~ta, at their
lax pms#r Opi~ ~t~Atim~ hM1d ®m t-l"i+~t ~8l~h dam/ of Ftbrtia~y
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3~~t1~4l+Nt! aad Jk. $~ Bu~riii.1.637.~k
They' r~rawiTS heir ~na~i~. addrssssd gow~td, ~t~~~.
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~~oa~~rat+~ seal)
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SCHEDULE OF MINNEAPOLIS GENERAL HOSPITAL CHARGES
Effective September 13, 1940
Bed charge per patient per day (no distinction is made between single rooms,
two bed rooms, ward beds or between non-contagious and contagious cases)
This charge does not include other specific charges listed below.
Flat daily rate 4k 3.25
Ambulance calls per trip within city limits of Minneapolis. 3.00
Ambulance calls on trips outside of City of Minneapolis, ~k3.00 base
charge, plus additional mileage beyond the city limits, mileage at
the rate per mile . .05
Delivery room, including laboratory and anesthesia procedure. 5.00
Operating room, minor operations, including laboratory and
anesthesia procedure. 5.00
Operating room, major operations, including laboratory and
anesthesia procedure . 10.00
X-ray service, per procedure. . 1.00
Dispensary service, per visit . 1.00
Receiving Ward service, when not brought in by ambulance, per visit 1.00
Home Visiting calls, per visit, . 1.00
Registration in Out-Pat~_ent Department. . .20
Each prescription, . . . .. .30
Special nurses board wil)_ be charged for at the rate of 60¢ per day.